Friedman Joseph H
Department of Neurology, Butler Hospital; and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI.
Clin Neuropharmacol. 2018 Sep/Oct;41(5):156-159. doi: 10.1097/WNF.0000000000000296.
Pimavanserin (Pim) is a 5HT2A inverse agonist that is the only Food and Drug Administration-approved treatment for Parkinson disease (PD) psychosis. The published open-label experience is limited.
This report is a chart review of all patients who were started on the drugs since the one earlier report on 15 patients. All patients were included, whether or not they completed 6 weeks of treatment, the time required for maximum benefit found in the published phase 3 trial.
Twenty-six patients are reported. Three patients had dementia with Lewy bodies; one had an atypical parkinsonism; 22 had PD, including one with schizophrenia and neuroleptic exacerbated, dopamine transporter scan-positive idiopathic PD; and another had PD complicated by strokes. Six stopped before 6 weeks due to adverse effects, including 1 with worsened psychosis. Eighteen completed at least 6 weeks of treatment. Of these, 3 stopped due to lack of efficacy and 3 due to worsened psychosis. Twelve found it helpful. Of the 18 who took Pim for at least 6 weeks, 12 improved and continue to take it.
Almost 50% of parkinsonian patients with psychotic symptoms found Pim to be a useful medication, which they continue to take. Reasons for intolerance varied and were thought to be unrelated to the drug.
匹莫范色林（Pim）是一种5HT2A反向激动剂，是美国食品药品监督管理局批准的唯一用于治疗帕金森病（PD）精神病的药物。已发表的开放标签经验有限。
本报告是对自之前一份关于15例患者的报告以来开始使用该药物的所有患者的病历回顾。所有患者均被纳入，无论他们是否完成了6周的治疗，这是已发表的3期试验中发现的获得最大益处所需的时间。
报告了26例患者。3例患有路易体痴呆；1例患有非典型帕金森综合征；22例患有PD，其中1例患有精神分裂症且因使用抗精神病药物而病情加重，多巴胺转运体扫描阳性的特发性PD；另1例患有PD并伴有中风。6例因不良反应在6周前停药，其中1例精神病症状恶化。18例完成了至少6周的治疗。其中，3例因缺乏疗效停药，3例因精神病症状恶化停药。12例认为该药有帮助。在服用Pim至少6周的18例患者中，12例病情改善并继续服用该药。
近50%有精神病症状的帕金森病患者发现Pim是一种有用的药物，并继续服用。不耐受的原因各不相同，且被认为与药物无关。
